Patient Education | Hip & Knee
“What else can I try before surgery?”
It is one of the most common questions patients with hip or knee pain ask—especially after physical therapy, injections, activity changes, or other conservative treatments have not provided enough relief.
During a recent Plymouth Bay Orthopedic Associates patient education event, R. Scott Oliver, MD, explained why the answer should not begin with a treatment name. It should begin with a different question: What is actually causing the pain, and what does the patient want to be able to do again?
Quick Answer
Hip and knee pain treatment before surgery may include physical therapy, activity modification, weight management, medications, injections, and selected biologic options such as PRP or Lipogems. The right choice depends on the diagnosis, arthritis severity, examination, imaging, prior treatments, and the patient’s goals. Advanced bone-on-bone arthritis may still be best served by a surgical evaluation.
Watch the Presentation
Non-Surgical Options for Hip & Knee Pain
Watch R. Scott Oliver, MD, discuss how diagnosis, arthritis severity, prior treatment response, and patient goals help guide treatment decisions before surgery.
1. Start With the Goal
Walking, stairs, sleep, work, travel, or activity: what the patient wants to regain helps shape the treatment plan.
2. Confirm the Diagnosis
Similar pain can come from different problems. History, examination, and imaging help clarify the source.
3. Match Care to the Stage
Early or moderate joint wear is a different clinical problem from severe, advanced bone-on-bone arthritis.
What Patients Really Want Is Usually Very Practical
Patients rarely walk into an orthopedic office because they want a specific procedure. They want to walk comfortably, climb stairs, get out of a chair, sleep with less pain, exercise, work, travel, or keep up with the people and activities that matter to them.
Those goals are clinically important. A treatment that makes sense for a patient trying to return to competitive activity may not be the same plan used for someone whose priority is walking through the grocery store without stopping because of knee pain.
Dr. Oliver’s message during the presentation was direct: understand the patient’s story and goals before building the treatment plan.
Hip and Knee Pain Treatment Before Surgery Starts With the Diagnosis
Hip and knee pain can come from arthritis, cartilage loss, meniscus problems, tendon irritation, bursitis, instability, or pain referred from another area. Similar symptoms do not always have the same cause.
An orthopedic evaluation typically combines the patient’s history, a physical examination, and imaging when appropriate. X-rays can show joint-space loss and arthritic change. MRI may be useful when more detail about cartilage, menisci, tendons, ligaments, or other soft tissues is needed. An MRI is not automatically necessary for every patient.
Non-Surgical Care Is a Treatment Sequence—Not a Menu of Injections
Once the diagnosis and stage of the joint problem are clearer, treatment can be matched to the patient. Depending on the condition, non-surgical care may include:
- Physical therapy to improve mobility, strengthen the muscles supporting the joint, and address movement limitations.
- Activity modification that reduces repeated irritation without automatically eliminating all activity.
- Weight management when excess body weight is increasing stress on a painful joint.
- Topical or oral medications for pain or inflammation when medically appropriate and not contraindicated.
- Injections used for a specific clinical purpose, with an understanding of the expected duration and limits of relief.
- Selected biologic or regenerative orthopedic options when the diagnosis and arthritis stage make them reasonable to consider.
This is also why prior treatment history matters. A patient who had meaningful temporary relief from an injection presents a different clinical question than a patient who has had repeated injections with little or no response.
The next step should answer a clinical question—not simply repeat the last treatment.
An orthopedic evaluation can review the diagnosis, imaging, prior treatment response, and what you want to get back to doing.
Where Steroid and Hyaluronic Acid Injections Fit
Steroid injections may reduce pain and inflammation for a period of time, but they are not a permanent solution and repeated use deserves an individualized discussion. The goal is to understand what the injection is expected to accomplish—and what the next step will be if the benefit is short-lived.
Hyaluronic acid, sometimes called a “gel shot,” has also been used for knee osteoarthritis. During the presentation, Dr. Oliver explained that he does not routinely rely on these injections. Current American Academy of Orthopaedic Surgeons guidance does not recommend hyaluronic acid injections for routine use in symptomatic knee osteoarthritis.
Where PRP and Lipogems May Enter the Conversation
For some patients, biologic or regenerative orthopedic treatments may also be part of the discussion. Dr. Oliver emphasized that these treatments should be considered in the context of the diagnosis and the stage of the joint problem—not selected simply because a patient has hip or knee pain.
PRP May Be Considered for Selected Patients—and Arthritis Stage Matters
Platelet-rich plasma, or PRP, is prepared from a patient’s own blood. The blood is processed to concentrate platelets, and the platelet-rich portion is injected into the area being treated.
In the presentation, Dr. Oliver emphasized that PRP is not a universal answer. It may be considered for selected patients, including some people with mild to moderate knee osteoarthritis and certain meniscus or tendon conditions. The degree of arthritis matters. Severe, advanced bone-on-bone disease is a different clinical problem than early or moderate joint wear.
PRP is also not automatically a “one and done” treatment. Depending on the condition and response, a treatment plan may involve one injection or a series. The plan should be individualized rather than applied as a fixed package to every patient.
Learn more about PBOA’s diagnosis-first PRP consultation
Lipogems Is Another Option for Selected Patients
Dr. Oliver also discussed Lipogems, a procedure that uses a patient’s own adipose, or fat, tissue. A small amount of tissue is collected, processed, and used as part of an orthopedic treatment plan.
The important distinction is what Lipogems is—and what it is not. It uses processed adipose tissue from the patient’s own body. It is not the same as isolated or laboratory-cultured stem cell therapy.
As with PRP, candidacy depends on the patient, the joint, the stage of the problem, medical history, and realistic treatment goals. A consultation should determine whether it is appropriate before any procedure is selected.
Sometimes Surgery Is the Right Answer
A non-surgical approach should not mean avoiding surgery at all costs. For some patients with advanced arthritis, major joint damage, deformity, or severe loss of function, joint replacement may be the treatment most likely to provide meaningful improvement.
The goal is to use the least invasive treatment that is likely to work—without delaying a treatment that is more appropriate for the actual problem.
For other patients, a non-surgical plan may improve pain and mobility, help them remain active, or give them time to improve strength and overall health before surgery is reconsidered.
The Goal Is Mobility—and the Plan Should Be Personal
The central takeaway from Dr. Oliver’s presentation was not that one treatment is better for every patient. It was that orthopedic care should connect the diagnosis, the stage of the condition, and the patient’s real-life goals.
For patients in Plymouth, Duxbury, Sandwich, across the South Shore, and in Cape communities, the starting point is an orthopedic evaluation that looks at the whole picture—not a consultation built around a single injection.
The better question is not “Which injection should I get?” It is “What is causing my pain, how advanced is the problem, and which treatment is most likely to help me reach my goal?”
Ready to Understand Your Options?
R. Scott Oliver, MD, evaluates hip and knee pain and discusses non-surgical, regenerative, and surgical treatment options based on the individual patient. To request an orthopedic evaluation, call Plymouth Bay Orthopedic Associates at 781-934-2400.
Frequently Asked Questions
Does “bone-on-bone” arthritis automatically mean I need joint replacement?
Not automatically. The degree of arthritis, pain, mobility, health history, examination, imaging, and response to prior treatment all matter. Advanced arthritis is more likely to require a surgical discussion, but the recommendation should be individualized.
Is PRP always one injection?
No. Depending on the condition and the patient’s response, PRP may be used as a single treatment or as part of a series. Dr. Oliver emphasized individualized treatment rather than a fixed protocol for every patient.
Is Lipogems stem cell therapy?
No. Lipogems uses processed adipose tissue collected from the patient’s own body. It is not isolated or laboratory-cultured stem cell therapy.
Do I need an MRI before choosing treatment?
Not every patient needs an MRI. The need for advanced imaging depends on the history, examination, X-rays, and the specific clinical question that still needs to be answered.
What if physical therapy or injections have already failed?
That history is part of the next decision. An orthopedic specialist should reassess the diagnosis, the severity of the joint problem, what treatments were tried, and how the patient responded before recommending another injection, a regenerative option, or surgery.
Related Care and Further Reading
About This Article
This article summarizes key takeaways from a Plymouth Bay Orthopedic Associates patient education presentation with R. Scott Oliver, MD, focused on non-surgical options for hip and knee pain and how diagnosis, arthritis stage, prior treatment response, and patient goals help guide the next step.
Clinical Guidance
American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty).
Medical disclaimer: This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Treatment recommendations depend on an individual evaluation and medical history.